Background

Injured, avascular skull is treated differently than other avascular bone. Bone is left in place to maintain protection of the brain. Vascularized tissue coverage often results in skull revascularization. If the skull is not revascularized, the fate of overlying flaps is in doubt.

Methods and Materials

Two patients sustained high-voltage injuries. Injuries to the head created full-thickness scalp loss with charring of the outer skull cortex, but the skull maintained its structural integrity. Free latissimus transfers were used for wound coverage.

Results

Months following free muscle transfer, small skin openings developed along the flap margins in both patients. CT and tagged WBC scans revealed resorption and chronic osteomyelitis of the underlying skull. Avascularized skull was removed and the defects were repaired with methyl methacrylate.

Conclusions

Accurate assessment of the degree of bone damage from electrical injury is challenging. Therefore, predicting the fate of injured bone is difficult. These cases support coverage of injured skull with a vascularized free flap without removal of bone. If bone trauma results in chronic infection and resorption, then resection and reconstruction of involved skull is necessary. These cases illustrate that no serious complications to underlying brain or overlying free flap are likely to occur.